Nurses caring for patients in a facility have the advantage of a controlled environment, predictable routines, and a team of clinicians working with them. Home health nurses working solo encounter far less predictable circumstances, including varied environments, situations, or schedules. Here are some tips to ensure success as a home health nurse in your community.

Top off the Fuel and Kick the Tires

Whether you drive your personal or company vehicle, keep the
car well-maintained and fueled. Treat the half-full mark on the gas gauge as
“empty”; don’t wait to look for gas when you’re on fumes in unfamiliar
territory. Make sure all the tires are properly inflated, including the spare.
Keep a flashlight in your car – you may need it one day. You’ll also want to
keep handy some vehicle chargers for your phone and your point of care device.
Nothing will throw your day into chaos like a DOA device that your daily
documentation and communication depend on.

Take Stock of Supplies

Clinical supplies should be stored in containers that
protect them from heat or moisture and kept in the trunk or hatch. It’s helpful
to organize the supplies by purpose so that you can retrieve exactly what you
need quickly. Keep track of your inventory and make note of what you use (and for
whom) to alert you when it’s time to restock specific items, as well as ensure
that the charge items can be applied to the proper patient’s account.

Safety First

It’s hard to fathom home health nursing before the advent of cellular phones. Home health requires a great deal of phone work such as calls to the home health office, physicians’ offices, pharmacies, colleagues, and of course, patients. And most of the call work occurs while you’re traveling between stops. Accepted wisdom recommends that we pull over to safely conduct phone calls in our vehicles, but that would make it impossible to get through the day in home health.

That’s why it’s smart to have a car phone cradle so that you can safely conduct hands-free calls. Nearly all smartphones have a voice assistant that makes calling without ever touching the phone a breeze. In addition, most late model cars are Bluetooth enabled, making hands-free calling even easier.

Lunch on the Run

Even in home health, a lunch break can be a rarity, so many nurses carry a cooler in their car. They stock them with water or other beverages to stay hydrated throughout the day, along with their lunch and snacks as desired. Packing your own lunch prevents spending on drive-through fast foods and can provide healthier choices as well.

Planning Makes Perfect

Respect the time of your patients’ and their families – schedule visits no later than the evening prior to the date you’d like to see them. It can often be ineffective to call much sooner than that, as patients’ schedules and circumstances can change with little notice. Generally, scheduling visits on the afternoon or evening before works well.

Map out the next days’ visit route in an orderly fashion to prevent zig-zagging across town, wasting time and fuel. Whether you choose to start with the patient closest to you or the one furthest away, scheduling your visits in a logical sequence is the most time-efficient plan.

Patients usually want to see their home care nurse first thing in the morning, which is physically impossible – no one can be everywhere at once. Do your best to accommodate the patients’ scheduling requests, but keep in mind you’ll have several patients to see in a workday. Try as you might, you won’t be able to satisfy everyone.

HIPAA Still Rules

Today, most home care agencies provide portable point of care devices on which clinicians submit their daily documentation. Maintain the privacy of all patients when using these devices in patient homes and in public spaces. Any paper documentation that you must carry with you should be kept in secure storage containers and not left loose in your vehicle.

Home health nursing can be very rewarding and can provide nurses with more variety and a flexible schedule. Keeping these pointers in mind can ensure safety and efficiency in daily practice.

Nursing is consistently voted the most trusted of all professions. One that involves providing medical and personal care for individuals at their most vulnerable. So, why should nurses consider carrying nursing liability insurance to protect themselves from litigation? Because we live in an increasingly litigious society. Nurses are human, and, unfortunately, they can make mistakes.

Upping the Odds?

Having your own policy does not increase your chances of being brought into litigation. Whether or not you—as a named defendant—have your own malpractice insurance policy wouldn’t be discovered until the lawsuit was actually filed. A plaintiff’s attorney “names multiple defendants in a lawsuit in an attempt to access additional sets of insurance limits and increase the chance for a higher settlement,” according to nurse attorney Katherine J. Pohlman, MS, RN, JD.

Look Out for Number One

The employers’ coverage protects the hospital’s liability first and foremost. Nurse employees may have protection in the case of a lawsuit, but they’d be relying on the attorney retained to protect the hospital and not a privately retained attorney hired to protect the nurse and their own interests. Under an employers’ insurance, nurses share the liability limitations (how much money is available to cover the lawsuit) with every other employee named in the litigation. And it’s possible that the award settlement may not be fully covered by that policy, resulting in potential out of pocket legal expenses for employees, including nurses. Further, the employers’ policy protection for nurses ends when that employment ends, meaning you can still be held liable even if you are working elsewhere at the time of the lawsuit.

Is There Enough to Go Around?

There are some positions which may not be covered by an
employer’s liability insurance, such as contract workers or travelers. Nurses
should not assume that they are covered and should inquire with their employer.
And how do nurses know what the limitations of liability are for that
coverage?

An individual policy belongs to the nurse and would clearly
identify what is covered and what the monetary limitations for litigation
awards would be. Most importantly, individual policies held by nurses will
follow them wherever they may work, even if they are a travel nurse or
self-employed.

Unanticipated Liabilities

Nurse liability insurance can protect nurses in ways that many nurses overlook. A nurse may not even make an error or cause harm to be named in a lawsuit. A patient who perceives wrongdoing can initiate litigation that can cause financial harm to individuals who have done nothing wrong. A nurse can be utterly meticulous in their practice and documentation and still find themselves embroiled in litigation, which can cost them dearly.

Many nurses are often casually asked for health-related advice by colleagues, friends, and family members. Well-intended advice that leads to someone pursuing a course of action (or not pursuing, as the case may be) could potentially lead to perceived or actual harm. An individual policy would protect a nurse in these circumstances as well.

Board Action

Lastly, individual policies protect nurses from actions taken against them by their Board of Nursing. Legal representation in this instance would be covered by the policy as well. Many advanced practice specialty nurses would be unwise to practice without it, such as nurse midwives, nurse anesthetists, and nurse practitioners.

Insurance provides protection. It’s why we carry homeowners
and automobile insurance. Surely the annual cost of nurse liability insurance
is a worthwhile expenditure in the face of the risk that nurses take when
caring for their patients.

Most people in the medical profession agree that a nursing career can often be stressful; it comes with the territory of caring for those who are ill and injured. And on an average day, well-trained nurses are more than capable of managing the day to day stressors that their profession brings. But there are also those occasional shifts that bring nurses to their knees, putting them in need of restorative tactics. Here are some solutions for bringing a nurse back from the brink after a rough shift.

After a rough shift, it helps to debrief with colleagues who have also had a tough day. Reviewing what didn’t go well and determining how events could have been better managed can be educational or reinforce that the decisions made were the best possible options. And the opportunity to share the days’ struggles can be a great bonding experience for the team.

Break up the routine. Take a different or longer route home.
Taking the long way home can provide valuable time to clear the mind and break
up the “autopilot” to which we tend to default on our commutes.

Play soothing or instrumental music on the radio,
or leave it off altogether. Patient care can be extremely noisy, especially in
acute and long-term care facilities. After a long shift of constant noise, a
little oasis of quiet can be very soothing. After you get home, continue to
limit external stimuli for a while. Keep that Zen mode going a little longer if
you’re able.

Are you a pet owner or lover? It’s a wonderful thing after a long day to be greeted at the door by a faithful companion, but take it a bit further. A long walk with your dog or some snuggle time with your cat, ferret, or another small animal can help you detach from the day. Your focus is shifted from your own worries to the needs and appreciation of your furry friend. If you don’t have a pet yourself, perhaps you can visit a friend or neighbors’ dog. Petting an animal lowers blood pressure and facilitates the release of relaxation hormones.

Even if your work isn’t necessarily as grimy as some careers, most nurses make it a point to bathe after a shift. A shower or a soak in the tub cleanses off the residue of the day and leaves you fresh and ready for bed.

However you choose to spend your time after a rough shift, it’s important to make sure that you know how to take care of yourself.

Gastroenterology nurses use their skills and experience specifically in the areas related to gastrointestinal issues. They address the care for any illness, condition, or dysfunction occurring anywhere in the digestive tract; the body’s system which takes in, processes for absorption, and eliminates the food we consume for the nutrition of our bodies. But they also do so much more on a daily basis so make sure you are prepared if you’re considering transitioning into this specialty.

One of their most commonly known responsibilities is preparing patients for endoscopies—diagnostic procedures for detecting illnesses within the upper and lower digestive tracts—and caring for patients as they recover. They educate patients about the procedure, any preparation required, and what to expect afterward. But they also care for their patients through whatever condition may be diagnosed as a result of those endoscopies.

They also assist with more specialized procedures, such as those that measure things like transit time (the time it takes the food we eat to make the trip through the digestive system), pH levels in the digestive tract to evaluate for reflux, or esophageal motility studies to evaluate the function of the esophageal sphincter (the dysfunction of which also contributes to reflux).

Often, patients are struggling with a diagnosis that has altered the way they’re able to live their lives. Gastroenterology specialty nurses help to educate them about how to manage their condition, prevent symptom flare-ups, and provide alternative solutions while managing their condition. These nurses educate patients about specific diets that may alleviate symptoms and prevent further complications.

Gastrointestinal nurses also work with patients who have
ostomies. They educate patients regarding their necessity and how to manage and
care for them; and when appropriate, prepare and educate them regarding the
reversal of the ostomy.

One of the most important roles a nurse plays in gastroenterology nursing—and all nursing—is assisting patients in setting and managing expectations for their care. This is a critical task whether the nurse is working with a healthy individual or one who has received chronic or even catastrophic diagnoses. An experienced, skillful nurse is able to help their patients maintain realistic expectations while working toward optimum health.

Be sure to check out more information here if you’re curious about gastroenterology nursing.

Fast Facts about GI and Liver Diseases for Nurses

What APRNs Need to Know in a Nutshell

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Working in gerontological nursing can be immensely rewarding, but in order to be successful, it’s critical to familiarize yourself with the characteristics unique to this age group. Here are some key areas to focus on if you are pursuing a career in adult-gerontology acute care nursing.

Generations previous to our own often have different sociocultural norms. Being mindful of this will facilitate their care. They may be uncomfortable being addressed by their first name, or they may be very private. Giving respect and space where needed will go a long way toward earning their trust and confidence, making it easier to care for them effectively.

Even elderly individuals without a cognitive impairment can
experience a sudden change in mentation, often triggered by infection (UTIs are
common culprits) or by a change in routine, geography or both. Safety is
paramount, so be mindful of their room assignment as well as their potential
for confusion to ensure that they are well monitored.

The elderly often lose acuity of one or more senses, so it’s important to accommodate these changes. Due to decreased activity levels, muscle mass, and food intake, they often complain of feeling cold. This is also attributable to chronic conditions such as anemia, kidney disease, underactive thyroid, or even the medications they take.

Offer them warm blankets, light jackets, or slipper socks to help their bodies retain warmth. Adjust the room temperature as appropriate. Elderly patients often will ask that their hot beverages or food be reheated. This alteration in heat perception is quite common in older patients, so reheat with caution to avoid injury.

Their hearing and vision are likely to be impaired to some degree, so speak deliberately and clearly. Let them see your face as you’re speaking. Repeat what you’ve said when asked. And encourage the use of eyeglasses and hearing aids where indicated.

Functional impairments such as balance issues and weakness are common among the elderly. They should be closely monitored or assisted when ambulating. Be mindful of hazards that may cause falls: furniture placed too closely together, uneven walking surfaces, throw rugs, electrical cords, and IV tubing. Weakness may necessitate the use of assistive devices to ambulate. Monitor transfers to determine whether they may need greater assistance for the transfer order.

Due to their nutritional status, chronic conditions, and medication, many will have fragile skin—their skin may have a papery texture and is easily prone to tears and lacerations. Protect it by keeping it clean and well-moisturized. Choose an appropriate tape for dressings, IV tubing, etc.; this will help minimize damage to the skin and potential allergic reactions, or when appropriate use mesh sleeves.

Constipation is another common complaint, related to decreased fluid intake, reduced activity, and polypharmacy. Monitor their diet and fluid intake for fiber, nutrients, and adequate hydration; and encourage activity and fluids as tolerated per their doctor’s orders.

Want to know more about adult-gerontology acute care nursing? Visit here to determine which certification may be right for you.